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Optic Nerve Head Volumetry by Optical Coherence Tomography in Papilledema Related to Idiopathic Intracranial Hypertension.
Transl Vis Sci Technol. 2020 02 21; 9(3):24.TV

Abstract

Purpose

Idiopathic intracranial hypertension (IIH) leads to optic nerve head swelling and optic atrophy if left untreated. We wanted to assess an easy to perform volumetric algorithm to detect and quantify papilledema in comparison to retinal nerve fiber layer (RNFL) analysis using optical coherence tomography (OCT).

Methods

Participants with and without IIH underwent visual acuity testing at different contrast levels and static perimetry. Spectralis-OCT measurements comprised standard imaging of the peripapillary RNFL and macular ganglion cell layer (GCL). The optic nerve head volume (ONHV) was determined using the standard segmentation software and the 3.45 mm early treatment diabetic retinopathy study (ETDRS) grid, necessitating manual correction within Bruch membrane opening. Three neuro-ophthalmologists graded fundus images according to the Frisén scale. A mixed linear model (MLM) was used to determine differences between study groups. Sensitivity and specificity was evaluated using the area under the receiver-operating characteristic (ROC).

Results

Twenty-one patients with IIH had an increased ONHV of 6.46 ± 2.36 mm3 as compared to 25 controls with 3.20 ± 0.25 mm3 (P < 0.001). The ONHV cutoff distinguishing IIH from controls was 3.97 mm3 (i.e. no patient with IIH had an ONHV below and no healthy individual above this value). The area under the curve (AUC) for ONHV was 0.99 and for the RNFL at 3.5 mm 0.90. The Frisén scale grading correlated higher with the ONHV (r = 0.90) than with the RNFL thickness (r = 0.68). ONHV measurements were highly reproducible in both groups (coefficient of variation <0.01%).

Conclusions

OCT-based volumetry of the optic nerve head discriminates very accurately between individuals with and without IIH. It may serve as a useful adjunct to the rating with the subjective and ordinal Frisén scale.

Translational Relevance

A simple OCT protocol run on the proprietary software of a commercial OCT device can reliably discriminate between normal optic nerve heads or pseudo-papilledema and true papilledema while being highly reproducible. Our normative data and OCT preset may be used in further clinical studies.

Authors+Show Affiliations

Department of Neuroophthalmology, Eye Center, Medical Center, Medical Faculty, University of Freiburg, Germany.Department of Neuroophthalmology, Eye Center, Medical Center, Medical Faculty, University of Freiburg, Germany.Department of Neuroophthalmology, Eye Center, Medical Center, Medical Faculty, University of Freiburg, Germany.Department of Neuroophthalmology, Eye Center, Medical Center, Medical Faculty, University of Freiburg, Germany.Department of Neuroophthalmology, Eye Center, Medical Center, Medical Faculty, University of Freiburg, Germany.NeuroCure Clinical Research Center, Universitätsmedizin, Universität, Berlin, Germany. Department of Neurology, University of California, Irvine, CA, USA.Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany.Department of Neurology and Neurophysiology, Medical Center, University of Freiburg, Germany.Department of Neuroophthalmology, Eye Center, Medical Center, Medical Faculty, University of Freiburg, Germany.Department of Neuroophthalmology, Eye Center, Medical Center, Medical Faculty, University of Freiburg, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32742754

Citation

Dreesbach, Michelle, et al. "Optic Nerve Head Volumetry By Optical Coherence Tomography in Papilledema Related to Idiopathic Intracranial Hypertension." Translational Vision Science & Technology, vol. 9, no. 3, 2020, p. 24.
Dreesbach M, Joachimsen L, Küchlin S, et al. Optic Nerve Head Volumetry by Optical Coherence Tomography in Papilledema Related to Idiopathic Intracranial Hypertension. Transl Vis Sci Technol. 2020;9(3):24.
Dreesbach, M., Joachimsen, L., Küchlin, S., Reich, M., Gross, N. J., Brandt, A. U., Schuchardt, F., Harloff, A., Böhringer, D., & Lagrèze, W. A. (2020). Optic Nerve Head Volumetry by Optical Coherence Tomography in Papilledema Related to Idiopathic Intracranial Hypertension. Translational Vision Science & Technology, 9(3), 24. https://doi.org/10.1167/tvst.9.3.24
Dreesbach M, et al. Optic Nerve Head Volumetry By Optical Coherence Tomography in Papilledema Related to Idiopathic Intracranial Hypertension. Transl Vis Sci Technol. 2020 02 21;9(3):24. PubMed PMID: 32742754.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optic Nerve Head Volumetry by Optical Coherence Tomography in Papilledema Related to Idiopathic Intracranial Hypertension. AU - Dreesbach,Michelle, AU - Joachimsen,Lutz, AU - Küchlin,Sebastian, AU - Reich,Michael, AU - Gross,Nikolai J, AU - Brandt,Alexander U, AU - Schuchardt,Florian, AU - Harloff,Andreas, AU - Böhringer,Daniel, AU - Lagrèze,Wolf A, Y1 - 2020/02/21/ PY - 2020/8/4/entrez PY - 2020/8/4/pubmed PY - 2020/8/4/medline KW - idiopathic intracranial hypertension KW - optic nerve head volume KW - optical coherence tomography KW - papilledema KW - pseudotumor cerebri syndrome SP - 24 EP - 24 JF - Translational vision science & technology JO - Transl Vis Sci Technol VL - 9 IS - 3 N2 - Purpose: Idiopathic intracranial hypertension (IIH) leads to optic nerve head swelling and optic atrophy if left untreated. We wanted to assess an easy to perform volumetric algorithm to detect and quantify papilledema in comparison to retinal nerve fiber layer (RNFL) analysis using optical coherence tomography (OCT). Methods: Participants with and without IIH underwent visual acuity testing at different contrast levels and static perimetry. Spectralis-OCT measurements comprised standard imaging of the peripapillary RNFL and macular ganglion cell layer (GCL). The optic nerve head volume (ONHV) was determined using the standard segmentation software and the 3.45 mm early treatment diabetic retinopathy study (ETDRS) grid, necessitating manual correction within Bruch membrane opening. Three neuro-ophthalmologists graded fundus images according to the Frisén scale. A mixed linear model (MLM) was used to determine differences between study groups. Sensitivity and specificity was evaluated using the area under the receiver-operating characteristic (ROC). Results: Twenty-one patients with IIH had an increased ONHV of 6.46 ± 2.36 mm3 as compared to 25 controls with 3.20 ± 0.25 mm3 (P < 0.001). The ONHV cutoff distinguishing IIH from controls was 3.97 mm3 (i.e. no patient with IIH had an ONHV below and no healthy individual above this value). The area under the curve (AUC) for ONHV was 0.99 and for the RNFL at 3.5 mm 0.90. The Frisén scale grading correlated higher with the ONHV (r = 0.90) than with the RNFL thickness (r = 0.68). ONHV measurements were highly reproducible in both groups (coefficient of variation <0.01%). Conclusions: OCT-based volumetry of the optic nerve head discriminates very accurately between individuals with and without IIH. It may serve as a useful adjunct to the rating with the subjective and ordinal Frisén scale. Translational Relevance: A simple OCT protocol run on the proprietary software of a commercial OCT device can reliably discriminate between normal optic nerve heads or pseudo-papilledema and true papilledema while being highly reproducible. Our normative data and OCT preset may be used in further clinical studies. SN - 2164-2591 UR - https://www.unboundmedicine.com/medline/citation/32742754/Optic_Nerve_Head_Volumetry_by_Optical_Coherence_Tomography_in_Papilledema_Related_to_Idiopathic_Intracranial_Hypertension_ L2 - https://tvst.arvojournals.org/article.aspx?doi=10.1167/tvst.9.3.24 DB - PRIME DP - Unbound Medicine ER -